The Role of the Nurse in the Care and Management of Patients with Rheumatic Diseases Arising from the Current EULAR Recommendations: A Literature Review.

In some countries, restructuring of the healthcare system has contributed to the introduction of a new domain in professional nursing-the Advanced Practice Nurse (APN). In order to provide the highest quality of care to patients, nurses working at the advanced level are expected to develop knowledge and to initiate services and practices carried out in collaboration with other professionals. In 2018, the European League Against Rheumatism (EULAR) updated its recommendations for the role of the nurse in the management and care of patients with rheumatic conditions. The objective of the study was a presentation of the scope of medical services provided by nurses for patients with rheumatic diseases based on current EULAR recommendations. A review of the literature on the participation of nurses, as members of a multidisciplinary team, in the education, management, psychosocial support, and promotion of self-care in patients with rheumatic diseases was presented. The expert group formulated three overarching principles and eight recommendations. The literature review and expert recommendations indicated that nurses' tasks in relation to patients with rheumatic diseases should include an initial assessment of health needs, routine follow-up care, and counseling for patients on self-care and lifestyle changes. In the EULAR recommendations, nursing care is also defined as a practice model in which nurses, in collaboration with physicians, provide support, education, and disease monitoring to patients with rheumatic conditions. The requirement for extended nursing education at the advanced practice level, aimed at acquiring diagnostic, therapeutic, caring, and educational knowledge and skills was highlighted, particularly with regard to the EULAR recommendations.

Clinical form of asthma and vaccine immunity in preschoolers.

INTRODUCTION: Asthma is the most common chronic disease in children. Its exacerbation results from allergic and infectious diseases. AIM: To assess the influence of a clinical form of asthma on preschoolers' vaccine immunity following 3 years after the completion of the mandatory vaccination programme. MATERIAL AND METHODS: The study encompassed 172 preschool children with asthma being newly diagnosed, including 140 patients with mild asthma and 32 with moderate asthma, whose vaccine immunity (level of IgG-specific antibodies) was assessed after the mandatory early vaccines had been administered in the early childhood. Monovalent vaccines (HBV + IPV + Hib) along with a three-component combined vaccine (DTwP) and MMR were given to 86 children while a six-component combined vaccine (DTaP + IPV + Hib + HBV) along with a three-component MMR vaccine were administered to the remaining 86 children. The immunity class for particular vaccinations was assessed according to the manufacturers' instructions. RESULTS: Children suffering from mild asthma had considerably more frequently vaccinations administered on time (p < 0.001) and the type of vaccines (monovalent or highly-combined) administered did not have a significant influence on the clinical form of asthma in the children examined (p = 0.6951). Apart from the vaccines against hepatitis B and rubella where considerably more frequently a high level of antibodies occurred in children with mild asthma, the antibody levels to other vaccines, namely diphtheria, tetanus, pertussis, Hib and mumps, were not associated with the severity of asthma. CONCLUSIONS: Moderate asthma may have a negative impact on remote vaccine immunity to HBV and rubella.

Vaccinology Education of Nurses and the Current Immunoprophylaxis Recommendations for Children with Juvenile Idiopathic Arthritis.

INTRODUCTION: The immunosuppressive effect of the disease and the applied treatment in children with juvenile idiopathic arthritis increases the risk of infections. It is therefore essential that vaccinations be properly implemented and that a proper serological response is provoked after the vaccination. A competent nurse acting in compliance with the current recommendations constitutes one of the safety pillars of immunization of pediatric patients with juvenile idiopathic arthritis. AIM: To discuss evidence-based recommendations for immunization of pediatric patients with juvenile idiopathic arthritis in the context of nursing vaccination practice and vaccinology education. MATERIAL AND METHODS: A systematic review of the literature presenting evidence-based recommendations of the European League Against Rheumatism (EULAR) expert group on immunization of children with juvenile idiopathic arthritis. Compilation of source data selected subjectively by the authors in a standard literature search of Medline, Cochrane and Scopus databases, including both recommendations for immunization of children with juvenile idiopathic arthritis and the tasks to be performed by nurses in the course of vaccine administration. As part of the standard literature review of Medline, Cochrane and Scopus databases, including both recommendations for immunization of children with juvenile idiopathic arthritis and the tasks to be performed by nurses in the course of vaccine administration. RESULTS: Most vaccines are immunogenic and safe for patients with juvenile idiopathic arthritis. The use of attenuated vaccines in patients receiving long-term immunosuppressive treatment should be considered with particular caution. Education and further training of nurses should take into account the recommendations and principles of immunization regarding children with juvenile idiopathic arthritis. Nurses should present the current knowledge of active immunoprophylaxis in such a way as to encourage parents/guardians to vaccinate their children in accordance with the national guidelines. CONCLUSION: The recommendations of the European League Against Rheumatism place special emphasis on the use of active immunoprophylaxis in the form of vaccination in children with juvenile idiopathic arthritis. The immunization schedule must be adjusted to the applied JIA treatment regimen. Such a stance on this matter is highly important as treatment regimens increasingly include biological drugs. Correctly performed by a nurse, a vaccination procedure is an important determinant of the desired immunoprophylactic results and minimizes the risk of adverse events following immunization. The priority for a nurse who provides active immunoprophylaxis should be to systematically broaden her training in immunization of chronically ill children, including juvenile idiopathic arthritis.

A Review of Recommendations for Routine Immunization Services During COVID-19 Pandemic That are Relevant for Nursing Personnel Involved in the Implementation of Immunoprophylaxis.

Immunization programmes are of key importance for maintaining good health and protecting life. Disruption to routine immunization may increase the incidence of diseases that can be prevented by vaccinations. The aim of this review is to present the current recommendations on immunization services during the COVID-19 pandemic that are relevant for the nursing practice. It contains an overview of recommended guidelines published in March and April 2020, and of scientific publications on immunizations for children and adults, taking into account recommendations related to the new epidemiological risk caused by SARS-CoV-2 infections. The ongoing global pandemic of COVID-19 calls for changes in the organization of health care and puts an additional burden on all resources forming the healthcare system. The COVID-19 pandemic poses a particular challenge to public health, as active immunoprophylaxis should make it possible to control other infectious diseases. Protection against the spread of SARS-CoV-2 may hamper routine immunization services, which must be administered with particular regard to epidemiological safety. Nurses have always had an important role to play in the implementation and promotion of vaccinations and in emphasizing their importance for public health. Therefore, it is crucial that they have up-to-date information on vaccinological interventions that reduce the risk of transmission of SARS-CoV-2 infections.

Influence of environment on residence and selected demographic and clinical parameters of preschool children with IgE-dependent asthma.

INTRODUCTION AND OBJECTIVE: An important role in the pathogenesis of asthma in children is played by individual parameters and environmental factors, in particular, those related to the place of residence. The aim of this study was to assess the impact of the living environment on the basic demographic and clinical parameters of preschool children with IgE-dependent asthma. MATERIAL AND METHODS: 176 children (126 from urban and 52 from rural areas) aged 5.22±0.34 years, with newly-diagnosed IgE-dependent asthma, hospitalised at the Clinic for Lung Diseases and Paediatric Rheumatology of the Prof. Antoni Gebala Children's Hospital of Lublin, were qualified for the study. Medical documentation of the children was analysed, including the implementation of vaccinations. Due to the clinical form of the disease, patients were separated into groups with mild, moderate and severe asthma. RESULTS: No statistically significant differentiation was observed between age and current body weight and height of the children. Similarly, gender and the clinical form of asthma were not significantly correlated with the place of residence. Children with asthma, at the time of exacerbation symptoms of the disease, living in a city, significantly more often (p <0.05) were treated with antibiotics in the hospital during hospitalization, while the value of OR (5.08) indicated that the rural environment enforces more frequent use of OGCs during asthma exacerbation therapy. In children from the urban environment, there was a significant correlation between the current body weight and serum calcium concentration, as well as a negative statistically significant correlation between the current body weight and serum selenium concentration. CONCLUSIONS: Residence does not determine the clinical course of IgE-dependent asthma in preschool children.

Demographic and medical factors affecting short-term changes in subjective evaluation of asthma control in adolescents.

INTRODUCTION: Asthma control is an important measure of disease stabilization, which is linked to the treatment and lifestyle recommendations. AIM: To assess the impact of selected factors on asthma control in adolescents, as assessed using the Asthma Control Test (ACT™). MATERIAL AND METHODS: The prospective study included 100 asthma patients aged between 12 and 19. Asthma was assessed in three consecutive follow-up visits spaced 3 months apart, using the standardized ACT™ questionnaire. RESULTS: Asthma was fully controlled (ACT score = 25 points) in more than half of the patients in all follow-up visits (53.0%, 54.0%, and 56.0%, respectively). More than one third of the participants scored between 20 and 24 points (37.0% vs. 39.0% vs. 40.0%). A minority of patients had uncontrolled asthma (scores below 20), and the group consistently diminished in subsequent visits (10% vs. 7% vs. 4%). Uncontrolled asthma was found significantly more often in female patients (33.33%; p < 0.001) and those living in rural areas (20.59%; p < 0.01). Treatment with a combination of inhaled corticosteroids (ICS) and LABAs was associated with worse asthma control (14.81%; p < 0.05). Better asthma control was found in patients with a family history of allergies (73.85% vs. 75.38% vs. 78.46%; p < 0.001) and in those with concurrent allergies (66.67% vs. 68.00% vs. 70.67%; p < 0.001). CONCLUSIONS: Asthma control in adolescents differs by sex and residence. Concurrent allergies and family history of allergies improve asthma self-control in adolescents.

In Search of Factors Negatively Affecting Vaccine Immunity to Pertussis in Preschool Children Before the Administration of the First Booster.

INTRODUCTION: The top priority for active immunoprophylaxis of pertussis is the immunisation of infants as they can sometimes develop severe multiple-organ complications. OBJECTIVES: The aim of the work is the identification of factors negatively affecting vaccine immunity to pertussis in preschool children prior to the administration of the first booster. PATIENTS AND METHODS: The research was conducted on 352 children from 4.5 to 5.9 years of age who were hospitalised in the University Children's Hospital in Lublin (Poland) from 1 January 2012 to 31 December 2015. The children taking part in the study had been administered all the mandatory vaccines from their birth to the age of 2 or 2.5 years old according to the Polish Immunisation Program 2008⁻2009. The immunoenzymatic method ELISA (enzyme-linked immunosorbent assay) was applied to assess vaccine immunity to tetanus, diphtheria, pertussis, Haemophilus influenzae type b (Hib), poliomyelitis (IPV), mumps, rubella and measles. The level of vaccine antibodies to hepatitis type B was determined chemilumiscently. RESULTS: The protective antibody titre was not found in 41 (11.65%) children before the administration of the booster. To verify the collective impact of parameters analysed on antibody titre to pertussis, the Generalized Linear Model (GLZ) was used. Gender, type of vaccine, asthma, Hib and mumps antibody titres have been shown to be predictors of vaccine immunity to pertussis. CONCLUSIONS: Immunomodulation considered on the example of titre of IgG antibody to pertussis can serve as a useful model of the assessment of development of acquired immunity after mandatory vaccinations.

Persistence of Vaccine-Induced Immunity in Preschool Children: Effect of Gestational Age.

BACKGROUND A program of immunization that ensures optimal development of acquired immunity should be carried out in all healthy newborns. The aim of the present study was to verify, at 2.5-3 years after the last dose of basic vaccination, if preschool children who have been delivered preterm and at term differ in their levels of post-vaccination protective antibodies. MATERIAL AND METHODS Humoral response was assessed in 352 children (mean age: 5.22±0.34 years) who received a series of obligatory vaccinations in the period from birth to 2.5-3 years of age. Antibodies (in IgG class) against vaccine antigens - diphtheria (D), tetanus (T), pertussis (P), Haemophilus influenzae type b (Hib), poliomyelitis (IPV), measles, mumps, and rubella (MMR) - were measured using ELISA. The level of antibodies against hepatitis B (HBV) was assessed by chemiluminescence. RESULTS All children had been immunized according to the Polish National Vaccination Program. The group of 352 children eligible for the study included 46 (13.1%) preschoolers delivered preterm (32-36 weeks of gestation), and 306 (86.9%) born at term (37-42 weeks of gestation). All children maintained seroprotective antibody levels against polioviruses type 1, 2, and 3 (>12 mIU/mL), and against measles antigens (>300 U/mL). No statistically significant differences were found in the proportions of preschoolers born preterm and at term who were seroprotected against other vaccine antigens. CONCLUSIONS Among preschool children who were immunized according to chronological age, those we were born late preterm do not seem to differ in vaccine-induced immunity from those who were born full-term.

Place of residence does not significantly influence radiological morphology of cervical cancer.

INTRODUCTION AND OBJECTIVE: Cervical squamous cell carcinoma is one of the most common malignancies of women. Its incidence and morphology was analyzed based on the magnetic resonance (MR) data among rural and urban residents. MATERIAL AND METHODS: The study involved 61 Caucasian women (58.26±9.63 years) preliminary diagnosed with a cervical cancer without any previous treatment. Standard MR examination, including diffusion weighted imagining, apparent diffusion coefficient (ADC) value measurement and dynamic contrast enhancement, was performed. RESULTS: The rural residents (n=22) were insignificantly older. Their first and last menstruation were observed later and number of pregnancy was higher than in urban women (n=39). However, the incidence of miscarriage was insignificantly rarer. All the tumour linear diameters as well as its volume were insignificantly higher in rural women. The ADC value of the cervical tumor was insignificantly lower, while ADC of lymphatic nodules was higher in rural women. Insignificant changes in tumour grade between both examined groups were found in histological, clinical and radiological examinations. Place of residence did not influence any clinical symptoms nor tumour volume and its ADC. Colporrhoea and colpodynia were insignificantly more often observed in urban women, while parametrium, urinary bladder and rectal infiltrations were more commonly seen in rural residents. Higher risk of lymphatic spread to the internal iliac and parametral lymphatic nodes was reporte[b]d in the rural community. CONCLUSIONS: Cervical cancer had similar morphology and growth pattern, regardless of the place of residence. However, a insignificantly larger tumour size among rural residents may suggest a higher incidence of lymphatic spread, probably as a result of less aaccess to modern health care.

Magnetic resonance imaging and endorectal ultrasound for diagnosis of rectal lesions.

Endorectal ultrasonography (ERUS) and magnetic resonance imaging (MRI) allow exploring the morphology of the rectum in detail. Use of such data, especially assessment of the rectal wall, is an important tool for ascertaining the perianal fistula localization as well as stage of the cancer and planning it appropriate treatment, as stage T3 tumors are usually treated with neoadjuvant therapy, whereas T2 tumors are initially managed surgically. The only advantage of ERUS over MRI is the possibility of assessing T1 tumors that could be treated by transanal endoscopic microsurgery. However, MRI is better for visualizing most radiological prognostic features in rectal or anal cancer such as a circumferential resection margin less than 1 mm, T stage at T1-T2 or T3 tumors with extramural extension less than 5 mm, absence of extramural vascular invasion, N stage at N0/N1, and tumors located in the middle or upper third of the rectum. It can also evaluate the intersphincteric space or levator ani muscle involvement. Increased signal on diffusion weighted imaging (DWI) and low apparent diffusion coefficient (ADC) values as well as an irregular contour and heterogeneous internal signal intensity seem to predict the involvement of pelvic lymphatic nodes better than their size alone. Computed tomography as well as other examination techniques, including digital rectal examination, contrast edema, recto- and colonoscopy, are less useful in staging of rectal cancer but still are very important screening tools.

[The influence of breathing mode on the oral cavity]. / Wplyw toru oddechowego na jame ustna.

Nose breathing is one of the key factors in the proper development and functioning of the oral cavity. The air passing through the nasal cavity is warmed and humidified while dust and other particulate matter is removed. It is also important as far as bone formation is concerned. The obstruction or congestions of the upper respiratory tract may negatively affect the correct and most optimal (nasal) respiratory tract. The switch from nasal to mouth breathing may lead to serious clinical consequences. Children with the clinical diagnosis of mouth breathing are usually pale, apathetic and they lack concentration and often get tired. Disorders resulting from hypoxy may also be the reason from sleep disturbances, such as frequent waking-up, nocturia, difficulties falling aslee. The main clinical manifestations of mouth breathing appear in the craniofacial structures. Mouth breathers frequently suffer from dental malocclusions and craniofacial bone abnormalities. Chronic muscle tension around the oral cavity could result in the widening of cranio-vertebral angle, posterior position of mandibula and narrow maxillary arch. Among dental alterations the most common are class II malocclusion (total or partial) with the protrusion of the anterior teeth, cross bite (unilateral or bilateral), anterior open bite and primary crowded teeth. Apart from malocclusion, chronic gingivitis, periodontitis, candida infections and halitosis are frequently present in mouth--breathing patients.

[Alcohol dependence syndrome--symptoms in the oral cavity]. / Nastepstwa uzaleznienia od alkoholuobserwowane w jamie ustnej.

Alcohol dependence syndrome is defined as a cluster of physiological, behavioural and cognitive phenomena in which the use of a psychoactive substance takes on a much higher priority for a given individual than other behaviours that once had greater value. In European Union the problem of the addiction affects about 5% of men and 1% of women each year. Long lasting alcohol abuse is detrimental to the whole body, including the oral cavity. The observable changes are usually caused by a convergent impact of a number of factors. The changes differ depending on the chemical features of the consumed substance, the life style adopted - as a consequence of the addiction, simultaneous addiction to nicotine, and finally on the medical treatment applied at different stages of the disease. Pathological changes may occur in all structures in oral cavity (teeth, periodontium, tongue, mucose membrane and salivary glands). Individuals addicted to alcohol revealed high percentage of carious losses and chemical damage enamel and dentine and inflammatory changes of the periapical area of teeth. Presence of these changes is linked unfortunately with low indicator of treatment. There is independence between alcohol addiction and damage of periodontium (clinical attachment level and pocket depth). Results of alcohol abuse may be also double-sided, painless, noninflammatory and non-malignant swelling on salivary glands (sialosis). Alcohol is said to be the risk factor for development of flat-epithelial cancer of the oral cavity. The most frequent localization of cancerous changes is the bottom of the oral cavity and the side of the tongue.

Incidence of spinal perineurial (Tarlov) cysts among East-European patients.

The spinal perineurial cyst (Tarlov) is a dilatation between the perineurium and endoneurium of spinal nerve roots, located at level of the spinal ganglion and filled with cerebrospinal fluid but without communication with the perineurial subarachnoid space. The aim of the study was to evaluate it incidence among East-European patients. The retrospective data collected during various magnetic resonance spinal examinations and stored on the picture archiving and communication system was analyzed for an incidence of perineurial cysts. From among 842 patients that underwent examination, 75 cases perineurial cysts were revealed. In 22 cases single anomalies were found. In remaining 53 cases, multiple uni- or less frequently bilateral changes were noted. The most common position was the sacral canal, particularly the level of S2 and S3. Occasionally, cysts were also visible on the cervical, thoracic and lumbar level. Incidence of sacral perineurial cysts was significantly higher in females than in males. Similar data was found for single and multiple changes despite of their localization. Insignificant changes were seen for patient age and cyst size. Perineurial spinal cysts were the most frequently observed on the sacral level and such changes were more common in females.

Developmental outcome after exposure to cyclooxygenase inhibitors during pregnancy and lactation.

The developmental toxicity of non-selective (ibuprofen, piroxicam, tolmetin) and selective cyclooxygenase-2 inhibitors (DFU) was evaluated in rats. Compounds were administered separately from the eighth gestational to the seventh lactational day. After spontaneous delivery, the weight, length and number of fetuses were determined. The digital radiography and double-staining were used to evaluate the skeleton morphology and mineralization in 7-day-old pups. Maternal toxicity was also assessed. Although decrease in pup weight and length was found, no teratogenic effects were revealed. Decrease in the absolute bone optical density was noted in the groups exposed to the middle and highest doses of tolmetin and ibuprofen, respectively. Increase of the absolute bone density was observed in the groups treated with the middle and the lowest doses of piroxicam, as well as in pups born after the expected day. Non-selective cyclooxygenase inhibitors (non-steroidal anti-inflammatory drugs--NSAID) affected pups growth and influenced mineralization of the lumbar vertebrae.

[Expression of podoplanin in ovarian clear cell carcinoma].

INTRODUCTION: Podoplanin is a transmembrane glycoprotein expressed in endothelial lymphatic cells. It was proven to be a predictive marker in a variety of cancers e.g. mesothelioma and head and neck squamous-cell carcinoma. Ovarian clear cell carcinoma (OCCC) is a rare and unique histopathologic subtype of epithelial ovarian cancer (EOC). The molecular basis of that phenomenon remains unknown. OBJECTIVES: The aim of our study was to assess podoplanin expression on the protein level in OCCC. MATERIAL AND METHODS: Immunohistochemistry was performed on paraffin-embedded tissues from 19 patients with diagnosed OCCC. RESULTS: Podoplanin expression was present (moderate or strong) in 52% of OCCC cases (10/19). Nine of eleven (81.2%) postmenopausal and one of eight (12.5%) premenopausal women were podoplanin positive. No differences in podoplanin expression were found in relation to clinical features of the tumor CONCLUSION: The incidence of podoplanin expression is higher in ovarian clear cell adenocarcinoma in postmenopausal patients.

Unusual interleukin-1 and -6 expression in fetal cartilage is associated with placental abnormalities.

Unusual expression of interleukin-1alpha, -1beta and -6 was previously found in the epiphyseal cartilage of rat fetuses prenatally exposed to various non-steroidal anti-inflammatory drugs (NSAID, i.e., ibuprofen, piroxicam, tolmetin) and selective cyclooxygenase-2 inhibitor (DFU). The aim of the present study was to evaluate the role of placenta in such phenomenon. Morphology of the organ, thickness of basal and labyrinth layer, immunoexpression of COX isoenzymes were examined, and confronted with maternal biochemical data and fetal developmental parameters. Higher maternal urea level, as well as lower placental weight and labyrinth thickness were found in the group of fetuses who revealed expression of genes coded the selected interleukins, when compared with the xenobiotic-exposed pups without the selected genes expression and untreated control. A significant correlation between placental weight and maternal total protein or urea level was revealed. Histological changes like inflammatory infiltration and calcification were observed sporadically. Location and intensity of COX-1 staining was similar in all cases. However, more intense COX-2 staining for majority of cells of the basal zone and in dispersed giant cells of the labyrinth was found in inflamed organs. It could be concluded that abnormal expression of the selected interleukins is associated with low placental weight and decrease of its thickness, especially labyrinth zone, as well as with high maternal urea level.

Morphology and physiology of the epiphyseal growth plate.

The epiphyseal growth plate develops from the cartilaginous-orientated mesenchymal cells that express SOX family genes. This multilayer structure is formed by the proliferation and hypertrophy of cells that synthesize the extracellular matrix composed of collagen (mainly type II, IX, X, XI) and proteoglycans (aggrecan, decorin, annexin II, V and VI). The resting zone is responsible for protein synthesis and maintaining a germinal structure. In the proliferative zone, cells rapidly duplicate. The subsequent morphological changes take place in the transformation zone, divided into the upper and lower hypertrophic layers. In the degenerative zone, the mineralization process becomes intensive due to increased release of alkaline phosphate, calcium and matrix vesicles by terminally differentiated chondrocytes and some other factors e.g., metaphyseal ingrowth vessels. At this level, as well as in the primary and secondary spongiosa zones, chondrocytes undergo apoptosis and are physiologically eliminated. Unlike adult cartilage, in fetal and early formed growth plates, unusual forms such as authophagal bodies, paralysis and dark chondrocytes were also observed. Their ultrastructure differs greatly from apoptotic and normal cartilage cells. Chondrocyte proliferation and differentiation are regulated by various endocrine, paracrine, and autocrine agents such as growth, thyroid and sex hormones, beta-catenin, bone morphogenetic proteins, insulin-like growth factor, iodothyronine deiodinase, leptin, nitric oxide, transforming growth factor beta and vitamin D metabolites. However, the most significant factor is parathyroid hormone-related protein (PTHrP) which is synthesized in the perichondrium by terminally differentiated chondrocytes. Secondary to activation of PTH/PTHrP receptors, PTHrP stimulates cell proliferation by G protein activation and delays their transformation into prehypertrophic and hypertrophic chondrocytes. When proliferation is completed, chondrocytes release Indian hedgehog (Ihh), which stimulates PTHrP synthesis via a feedback loop. Any disturbances of the epiphyseal development and its physiology result in various skeletal abnormalities known as dysplasia.

Maternal toxicity of nonsteroidal anti-inflammatory drugs as an important factor affecting prenatal development.

PURPOSE: Treatment-related signs of maternal toxicity, intrauterine growth retardation, increased skeletal developmental variations, and decreased bone ossification have been reported previously in rats exposed to high doses of non-selective cyclooxygenase (COX) inhibitors (ibuprofen, piroxicam, and tolmetin), also known as nonsteroidal anti-inflammatory drugs (NSAID). On the other hand, decrease in fetal length has been the only sign of toxicity found after exposure to selective COX-2 inhibitor (DFU). The aim of the study was to evaluate maternal effects on selected developmental abnormalities. METHODS: Data on postimplantation loss, fetal weight and length, placental weight, external and skeletal malformations and developmental variations were examined in the control and common COX-inhibitors-exposed groups, in relation to selected maternal blood biochemical parameters. RESULTS: Abnormal maternal urea level was found in mothers that gave birth to litters with low fetal weights and high incidence of skeletal malformations. Increased incidence of developmental variations and higher placental weights were also noted in this group. The number of litters with postimplantation loss, external malformations, external and skeletal variations was higher for dams with abnormal urea levels. A high incidence of external developmental variations was also seen in the offspring of dams with abnormal protein level. The highest embryo and/or fetal mortality were revealed in litters of dams with high urea and low total protein levels, simultaneously. In utero exposure to the examined COX-inhibitors increased the risk of developmental skeletal variations (OR=1.74). CONCLUSION: Maternal toxicity is an important factor affecting prenatal development during in utero exposure to nonsteroidal anti-inflammatory drugs.

Expression of syndecan-1 and cathepsins D and K in advanced esophageal squamous cell carcinoma.

The key features of malignant neoplasms are their local invasiveness and metastatic potential. Syndecan-1 - integral membrane heparan sulfate proteoglycan and cathepsins D and K - lysosomal proteases are important factors influencing different aspects of these processes. The study was undertaken to determine their expression in esophageal squamous cell carcinoma, and analyze relationship to selected clinicopathological features as well as to survival. Formalin-fixed, paraffin-embedded sections from 39 advanced esophageal squamous cell carcinoma were used for immunohistochemical staining. The epithelial and stromal staining were evaluated separately and compared to conventional clinicopathological features and one-year survival. Positive epithelial immunostaining for syndecan-1, cathepsin D and K were observed in 82.05%, 56.41% and 30.77% of tumors, respectively. However, stromal staining was noted in 51.28%, 51.28% and 46.15% ones, respectively. Epithelial syndecan-1-positive cases were significantly more frequent in well- and moderately differentiated carcinomas. Stromal cathepsin D expression predominated in tumors with infiltrative growth pattern. However, there were no statistically significant differences between any marker-positive and -negative groups with respect to other clinicopathological features studied. The only factors significantly influencing one-year survival were epithelial cathepsin D staining and distant metastasis. In a group of patients who survived one year post surgery, the percentage of cases with negative epithelial cathepsin D staining and without features of distant metastasis were higher. The results may suggest a relationship between syndecan-1 and cathepsins D and K with growth and invasiveness of esophageal squamous cell carcinoma, but such thesis requires further study on a larger and more heterogeneous population.

Cyclooxygenase inhibitors affect bone mineralization in rat fetuses.

Intrauterine growth retardation, increased incidence of developmental variations, lack of cartilage and joint developmental side effects were previously reported for nonselective (ibuprofen, piroxicam, tolmetin) and selective (DFU) cyclooxygenase (COX)-2 inhibitors, also known as nonsteroidal anti-inflammatory drugs. The aim of the present study was to evaluate the lumbar vertebra mineralization in fetuses prenatally exposed to COX inhibitors. All the tested compounds were administered intragastrically to pregnant rats from gestational days 8 to 21. Fetuses were delivered on gestational day 21, and after digital radiological examination were double-stained with alcian blue and alizarin. Decrease of alizarin staining, as a qualitative sign of mineralization, was significantly greater in groups exposed to the highest doses of the nonselective COX inhibitors. Decrease of vertebra mineralization in drug-exposed groups was also revealed using quantitative radiological analysis. However, significant differences were noted only for the fifth and sixth lumbar vertebrae in the group exposed to the highest dose of tolmetin. Strong influence of the total protein level in maternal sera on the fetal bone optic density was found. It should be stressed that unlike DFU, the examined nonselective COX inhibitors decreased fetal bone mineralization when administered in high maternal toxic doses. Moreover, maternal health status determined fetal bone mineralization.